The Care Quality Commission is pushing through significant changes to the inspection regime on the back of a flawed consultation process, one of its own board members has warned.
The CQC has agreed a new approach in which inspectors will spend most of their time in trusts looking for non-compliance with standards, instead of compliance.
There is a fear this will force inspectors to focus on failure instead of trying to improve the quality of care. Non executive director John Harwood told the senior management team attending last Wednesday’s board meeting that the change had been seen as “vindictive” by some people.
In addition, from 1 April trusts will no longer be handed “improvement notices” or extended deadlines to comply with standards. Instead, they will be branded either compliant or non-compliant.
The changes were accepted by the majority of board members at the meeting.
But they were rejected by non executive member Kay Sheldon, who last year told the public inquiry into Mid Staffordshire Foundation Trust that the regulator discouraged board members from properly scrutinising its plans.
She said at last week’s CQC meeting she had “significant concerns” about the plans and the consultation was “not robust enough”.
The consultation paper was sent to 30,000 people and drew responses from 174 organisations and individuals, including seven from the CQC, and 69 from health and social care providers.
Five focus groups were also held. However, Ms Sheldon said the questions asked at the groups were often “yes/no, with no ‘I don’t know’ option”, and responses were not compiled in a methodical way.
Director of regulatory development Philip King responded: “I would’ve hoped for a greater level of response but [the team] have done their level best to [achieve this].” Other board members said the moves would allow the CQC to simplify its regulatory model.
But Ms Sheldon’s fears have been raised as wider questions are being asked about the way in which CQC inspections are being followed up. Information seen by HSJ reveals a third of hospitals at which inspectors raised concerns about the care of older people received no follow-up visit.
This is despite the regulator telling the public accounts committee last month it had “gone back to” “all” the trusts visited last year as part of a wave of reviews into dignity and nutrition standards, carried out at 100 hospitals.
The data seen by HSJ shows 18 of the 55 trusts in which concerns were found received no follow-up inspection.
A CQC spokeswoman said the concerns had been “less serious” at these trusts and action plans were required to demonstrate improvements were being made.
The board meeting also discussed the planned external evaluation of the regulator, revealed by HSJ two weeks ago.
A prior information notice has been issued, listing “a potential procurement to engage an organisation or consortium to work with CQC and key stakeholders, including people who use services, to design and deliver a targeted programme of activity to evaluate the impact, effectiveness and value for money of CQC’s approach to regulation”.
The procurement timescales are not set but it is anticipated that the tender will start from April.